Multiple Myeloma management strategies in adults
Multiple Myeloma management strategies in adults involve a multifaceted approach aimed at controlling the disease, prolonging survival, and improving quality of life. As a malignancy of plasma cells within the bone marrow, multiple myeloma presents unique therapeutic challenges, given its complex biology and tendency for relapse. Treatment strategies are tailored based on the patient’s age, overall health, disease stage, and specific genetic features of the tumor.
The foundation of multiple myeloma management typically includes systemic therapy, which aims to reduce tumor burden and induce remission. First-line treatments often involve combinations of immunomodulatory drugs (IMiDs) such as lenalidomide or thalidomide, proteasome inhibitors like bortezomib or carfilzomib, and corticosteroids such as dexamethasone. These regimens have significantly improved response rates and survival outcomes over the past decade. The choice of initial therapy depends on various factors, including disease risk stratification and patient comorbidities.
Stem cell transplantation remains a cornerstone of treatment for eligible patients, particularly those who are younger and have good performance status. Autologous stem cell transplantation (ASCT) after induction therapy can deepen responses and prolong remission durations. Most patients undergo high-dose melphalan conditioning followed by reinfusion of their own previously collected stem cells. While transplantation offers significant benefits, it is not curative, and most patients eventually experience relapse. Maintenance therapy post-transplant, often with lenalidomide, has become standard to sustain remission and improve survival.
For patients who are ineligible for transplant due to age or comorbidities, treatment focuses on prolonged, less intensive regimens. These may include continuous oral therapies and combination chemotherapy tailored to minimize toxicity. The goal is to achieve disease control while maintaining quality of life.
In addition to systemic therapies, supportive care plays an essential role in managing multiple myeloma. This includes the use of bisphosphonates or denosumab to prevent skeletal-related events, infection prophylaxis with vaccinations and antibiotics, and management of anemia or renal impairment. Pain control and physical therapy also help improve patient comfort and functionality.
In cases of relapsed or refractory disease, second-line treatments may involve different drug combinations, monoclonal antibodies such as daratumumab, or newer agents like CAR T-cell therapies and bispecific T-cell engagers. Clinical trials are increasingly vital in this setting, providing access to innovative therapies that can offer new hope for patients with resistant disease.
Overall, managing multiple myeloma requires a personalized approach that incorporates initial aggressive treatment, maintenance strategies, supportive care, and innovative therapies at relapse. Multidisciplinary teams including hematologists, oncologists, and supportive care specialists are essential to optimize outcomes and improve the quality of life for adults living with this complex disease.
